Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

Great Place to Work®

Most Loved Workplace®

Forbes Best-in-State Employer

Workers Compensation Claims Associate | Medical Only | Orange, CA (In-Office)

PRIMARY PURPOSE : To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices. Also to provide support to the claims staff and to perform other office tasks depending on the client program.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.

Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.

Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.

Communicates claim action/processing with claimant, client and appropriate medical contact.

Ensures claim files are properly documented and claims coding is correct.

May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.

Maintains professional client relationships.

Inputs and reviews notes/diaries in claims management system as instructed.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Processes payments.

Processes mail; handles filing, faxing and photocopying.

Reviews, prepares, creates, and/or sends letters, reports, and forms.

Answers and initiates telephone calls, sets up medical appointments, and may provide customer service as required.

Other activities/projects as assigned including the preparation and distribution of computer reports.

Performs other duties as assigned.

Supports the organization's quality program(s).

QUALIFICATION

Education Licensing

High school diploma or GED required. Licenses as required.

Experience

One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.

Skills Knowledge

Excellent oral and written communication skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Good interpersonal skills

Ability to work in a team environment

Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

#entrylevel

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($19.22/hr - $26.91/hr). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Taking care of people is at the heart of everything we do. Caring counts

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts. Watch this video to learn more about us. (https://www.youtube.com/watch?v=ywxedjBGSfA)